Page 240 - ATP-P 11th Ed

HEADACHE PROTOCOL

SPECIAL CONSIDERATIONS
1. The number of differential diagnoses for the acute headache is large and includes
disorders that encompass the spectrum of minor to severe underlying disorders.
2. Consider altitude sickness, intracranial bleeds, meningitis and carbon monoxide
poisoning.
SECTION 2 Signs and Symptoms

1. If the headache is atypical for the patient, check for elevated blood pressure (if pos-
sible), fever, neck rigidity, visual symptoms, mental status changes, motor-sensory defi-
cits, and hydration.
Management
1. If the patient has fever, nuchal rigidity, photophobia, petechial rash, or nausea and vom-
iting, treat per Meningitis Protocol.
2. Treat per Pain Management Protocol (to exclude use of narcotics).
3. If headache is accompanied by nausea and/or vomiting, treat per Nausea and Vomiting
Protocol.
4. Oxygen if other therapies are ineffective.
5. If dehydration is suspected, treat per Dehydration Protocol.
6. If at altitude, treat per Altitude Illness Protocol.
Disposition
1. Evacuation is usually not required if the headache responds to therapy.
2. Acute headache in the presence of fever, severe nausea and vomiting, mental
status changes, focal neurological signs, or preceding seizures, loss of con-
sciousness, or a history of “it’s the worst headache in my life” constitutes a true
emergency and requires Urgent evacuation. Also consider Urgent evacuation for
anyone without a prior history of headaches if their pain is severe.

230 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 231